Baker IDI Heart and Diabetes Institute bSouthern Health, Melbourne, Victoria, Australia.
J Hypertens. 2012 Feb;30(2):253-66. doi: 10.1097/HJH.0b013e32834de621.
Although most national guidelines for the diagnosis and management of hypertension emphasize that the initiation and modification of blood pressure (BP)-lowering treatment should be related to absolute cardiovascular disease (CVD) risk, there is only limited information on how to incorporate ambulatory BP (ABP) monitoring into this framework. The objective of this initiative is to provide ABP equivalents for BP cut-points for treatment initiation and targets to be included into guidelines.
A critical analysis of the best available evidence from clinical trials and observational studies was undertaken to develop a new consensus statement for ABP monitoring.
ABP monitoring has an important place in defining abnormal patterns of BP, particularly white-coat hypertension (including in pregnancy), episodic hypertension, masked hypertension, labile BP and nocturnal or morning hypertension. This consensus statement provides a framework for appropriate inclusion of ABP equivalents for low, moderate and high CVD risk patients. The wider use of ABP monitoring, although justified, is limited by its availability and cost due to the lack of medical subsidy in Australia. However, cost-benefit analysis does suggest a cost-saving in reduced numbers of inappropriate antihypertensive treatments.
Although clinic measurement of BP will continue to be useful for screening and management of suspected and true hypertension, ABP monitoring provides considerable added value toward accurate diagnosis and the provision of optimal care in uncomplicated hypertension, as well as for patients with moderate or severe CVD risk.
尽管大多数国家的高血压诊断和管理指南都强调,降压治疗的启动和调整应与绝对心血管疾病(CVD)风险相关,但关于如何将动态血压(ABP)监测纳入这一框架的信息有限。本倡议的目的是提供用于治疗起始和目标的 BP 切点的 ABP 等效值,以纳入指南。
对临床试验和观察性研究的最佳可用证据进行了批判性分析,以制定 ABP 监测的新共识声明。
ABP 监测在定义异常血压模式方面具有重要作用,特别是白大衣高血压(包括妊娠期间)、间歇性高血压、隐匿性高血压、血压波动和夜间或清晨高血压。本共识声明为低、中、高 CVD 风险患者的 ABP 等效值的适当纳入提供了一个框架。尽管 ABP 监测的广泛应用是合理的,但由于澳大利亚缺乏医疗补贴,其可用性和成本限制了其应用。然而,成本效益分析确实表明,减少不适当的降压治疗数量可以节省成本。
虽然诊所测量的血压对于筛查和治疗疑似和真性高血压仍然有用,但 ABP 监测在准确诊断和为单纯性高血压以及中重度 CVD 风险患者提供最佳治疗方面提供了相当大的附加值。